DETAILED ACTION
Notice of Pre-AIA or AIA Status
The present application, filed on or after March 16, 2013, is being examined under the first inventor to file provisions of the AIA .
Status of Claims
This is the first office action in response to the applicant’s arguments/remarks filed on January 28, 2026.
Claim 2 has been amended.
Claims 1-18 are pending and have been examined.
Priority
The applicant’s claim for the benefit of a prior-filed application under 35 U.S.C. 119(e) or under 35 U.S.C. 120, 121, 365(c), or 386(c) is acknowledged.
Responses to Arguments/Remarks
Claim Objections:
The amened claim 2 has overcome the claim objection, and the claim objection has been withdrawn.
Double Patenting:
The Terminal Disclaimer filed on 01/28/2026 has been reviewed and disapproved with the comments of “Wrong form used. Must use PTO/AIA /26.” Therefore, the double patenting rejections remain.
35 U.S.C. § 101:
The applicant contends that the elements of claim 1 provide a practical application to support a network of nodes to cooperatively review and validate each other’s pharmacy-related transaction to prevent fraud without needing a central node, which if malfunctioning would bring down the entire system. The examiner respectfully disagrees.
Claim 1 of the instant application recites processing a reimbursement claim. Specially, the identified limitations fall within claim falls within the “Certain Methods of Organizing Human Activity” grouping of abstract ideas in Step 2A Prong One (MPEP 2106.04(a)(d)) because the claim involves the steps for processing a reimbursement claim by validating the claims via different entities, which is a process related to fundamental economic practices and/or commercial interactions.
The paragraphs [0021]-[0024] of the specification presented by the applicant describe a validation process based on a distributed network. Validating a transaction/claim by nodes of a distributed network without a central node and storing an immutable entry in a ledger are the regular features of the distributed network, such as a blockchain network. The nodes of the distributed network can act as validators or not. Specifically, a consortium or a permissioned/private blockchain can only be accessed by the allowed participants, so that the validation nodes of the consortium or the permissioned/private blockchain can be controlled/restricted. Utilizing the blockchain/distributed network to process different types of transactions has been a common approach. Validating a reimbursement claim by utilizing the regular features of a distributed network does not integrate the judicial exception into a practical application, and it is merely an improvement for the cited abstract idea itself.
The additional elements of computers, a computer network, and a pharmacy electronic ledger in claim 1 perform processing a reimbursement claim. These additional elements are recited at a high level of generality such that they amount to no more than mere instructions to apply the exception using generic computer components. Merely adding generic computer components to perform the abstract idea does not integrate the abstract idea into a practical application. The additional element of a pharmacy electronic ledger is only recited as a database for storing data associated with the reimbursement claim. The additional element of the pharmacy electronic ledger stored by the first pharmacy computer system merely describes the characteristics of the identified additional element of the pharmacy electronic ledger. Those additional elements do not involve improvements to the functioning of a computer, or to any other technology or technical field (MPEP 2106.05(a)); the claim does not apply the abstract idea with, or by use of, a particular machine (MPEP 2106.05(b)); and the claim does not apply or use the abstract idea in some other meaningful ways beyond generally linking the use of the abstract idea to a particular technological environment, such that the claim as a whole is more than a drafting effort designed to monopolize the exception (MPEP 2106.05(e) and Vanda Memo). Therefore, the claim does not, for example, purport to improve the functioning of a computer. Nor does it effect an improvement in any other technology or technical field. Accordingly, the additional elements do not impose any meaningful limits on practicing the abstract idea. Claim 1 as a whole, judging from the additional elements individually and in combination, does not integrate the judicial exception into a practical application. Therefore, claim 1 as a whole fails to recite a practical application of the abstract idea.
Double Patenting
The nonstatutory double patenting rejection is based on a judicially created doctrine grounded in public policy (a policy reflected in the statute) so as to prevent the unjustified or improper timewise extension of the “right to exclude” granted by a patent and to prevent possible harassment by multiple assignees. A nonstatutory double patenting rejection is appropriate where the conflicting claims are not identical, but at least one examined application claim is not patentably distinct from the reference claim(s) because the examined application claim is either anticipated by, or would have been obvious over, the reference claim(s). See, e.g., In re Berg, 140 F.3d 1428, 46 USPQ2d 1226 (Fed. Cir. 1998); In re Goodman, 11 F.3d 1046, 29 USPQ2d 2010 (Fed. Cir. 1993); In re Longi, 759 F.2d 887, 225 USPQ 645 (Fed. Cir. 1985); In re Van Ornum, 686 F.2d 937, 214 USPQ 761 (CCPA 1982); In re Vogel, 422 F.2d 438, 164 USPQ 619 (CCPA 1970); In re Thorington, 418 F.2d 528, 163 USPQ 644 (CCPA 1969).
A timely filed terminal disclaimer in compliance with 37 CFR 1.321(c) or 1.321(d) may be used to overcome an actual or provisional rejection based on nonstatutory double patenting provided the reference application or patent either is shown to be commonly owned with the examined application, or claims an invention made as a result of activities undertaken within the scope of a joint research agreement. See MPEP § 717.02 for applications subject to examination under the first inventor to file provisions of the AIA as explained in MPEP § 2159. See MPEP § 2146 et seq. for applications not subject to examination under the first inventor to file provisions of the AIA . A terminal disclaimer must be signed in compliance with 37 CFR 1.321(b).
The filing of a terminal disclaimer by itself is not a complete reply to a nonstatutory double patenting (NSDP) rejection. A complete reply requires that the terminal disclaimer be accompanied by a reply requesting reconsideration of the prior Office action. Even where the NSDP rejection is provisional the reply must be complete. See MPEP § 804, subsection I.B.1. For a reply to a non-final Office action, see 37 CFR 1.111(a). For a reply to final Office action, see 37 CFR 1.113(c). A request for reconsideration while not provided for in 37 CFR 1.113(c) may be filed after final for consideration. See MPEP §§ 706.07(e) and 714.13.
The USPTO Internet website contains terminal disclaimer forms which may be used. Please visit www.uspto.gov/patent/patents-forms. The actual filing date of the application in which the form is filed determines what form (e.g., PTO/SB/25, PTO/SB/26, PTO/AIA /25, or PTO/AIA /26) should be used. A web-based eTerminal Disclaimer may be filled out completely online using web-screens. An eTerminal Disclaimer that meets all requirements is auto-processed and approved immediately upon submission. For more information about eTerminal Disclaimers, refer to www.uspto.gov/patents/apply/applying-online/eterminal-disclaimer.
Claims 1-18 are rejected on the ground of nonstatutory double patenting as being unpatentable over claim 1-16 of U.S. Patent No. 12,211,036. Although the claims at issue are not identical, they are not patentably distinct from each other.
The mapping of claims 1-18 of this application with claims 1-16 of the ’036 patent is as follows:
This Application
Patent No. 12,211,036
Claim 1:
A decentralized method of initiating reimbursement of pharmacy-related transactions, the method comprising:
receiving, at a first pharmacy computer system associated with a first pharmacy, first pharmacy data about a pharmacy transaction between a patient and the first pharmacy, wherein the pharmacy transaction comprises dispensing of a medication by the first pharmacy to the patient;
generating, at the first pharmacy computer system, a pharmacy reimbursement data packet based on the first pharmacy data, wherein the pharmacy reimbursement data packet comprises second pharmacy data about a pharmacy reimbursement claim associated with the pharmacy transaction, the second pharmacy data including a quantity of the medication dispensed by the first pharmacy to the patient and a requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
transmitting, via a computer network, the pharmacy reimbursement data packet from the first pharmacy computer system to a first payer computer system associated with a first payer and to a plurality of second pharmacy computer systems of a plurality of second pharmacies outside of the transaction and listed in a pharmacy directory;
receiving, via the computer network, a pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems, wherein each pharmacy response indicates whether a respective one of the plurality of second pharmacy computer systems determined that the pharmacy reimbursement claim is valid, the pharmacy response of each second pharmacy computer system of the plurality of second pharmacy computer systems being determined based on a pharmacy condition involving the quantity of the medication and on the requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
determining that the pharmacy reimbursement claim is validated based on the pharmacy responses from the plurality of second pharmacy computer systems;
adding an immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to a pharmacy electronic ledger, the pharmacy electronic ledger being stored by the first pharmacy computer system, the immutable pharmacy entry being cryptographically signed by the first pharmacy computer system; and
transmitting, after adding the immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to the pharmacy electronic ledger, at least a portion of the pharmacy electronic ledger that includes the immutable pharmacy entry to the first payer computer system, at least the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger causing the first payer computer system to initiate processing of the pharmacy reimbursement claim.
Claim 1:
A decentralized method of initiating reimbursement of pharmacy-related transactions, the method comprising:
receiving first supply data about a supply transaction between a first wholesaler and a first pharmacy, wherein the supply transaction comprises supplying a medication by the first wholesaler to the first pharmacy;
generating a wholesaler reimbursement data packet based on the first supply data, wherein the wholesaler reimbursement data packet comprises second supply data about a wholesaler reimbursement claim, the second supply data including a quantity of the medication for the first pharmacy and a requested wholesaler reimbursement amount for the wholesaler reimbursement claim;
transmitting the wholesaler reimbursement data packet to a plurality of second wholesaler computer systems of a plurality of second wholesalers outside of the supply transaction and listed in a wholesaler directory;
receiving a wholesaler response from each second wholesaler computer system of the plurality of second wholesaler computer systems, wherein each wholesaler response indicates whether a respective one of the plurality of second wholesaler computer systems determined that the wholesaler reimbursement claim is valid, the wholesaler response of each second wholesaler computer system of the plurality of second wholesaler computer systems being determined based on a wholesaler condition involving the quantity of the medication and on the requested wholesaler reimbursement amount for the wholesaler reimbursement claim;
determining that the wholesaler reimbursement claim is validated based on the wholesaler responses from the plurality of second wholesaler computer systems;
adding an immutable wholesaler entry about the supply transaction and the wholesaler reimbursement claim to a first electronic ledger, the immutable wholesaler entry being cryptographically signed;
transmitting, after adding the immutable wholesaler entry about the supply transaction and the wholesaler reimbursement claim to the first electronic ledger, at least a portion of the first electronic ledger that includes the immutable wholesaler entry to each second wholesaler computer system of the plurality of second wholesaler computer systems;
receiving, at a first pharmacy computer system associated with the first pharmacy, first pharmacy data about a pharmacy transaction between a patient and the first pharmacy, wherein the pharmacy transaction comprises dispensing of the medication by the first pharmacy to the patient;
generating, at the first pharmacy computer system, a pharmacy reimbursement data packet based on the first pharmacy data, wherein the pharmacy reimbursement data packet comprises second pharmacy data about a pharmacy reimbursement claim associated with the pharmacy transaction, the second pharmacy data including a quantity of the medication dispensed by the first pharmacy to the patient and a requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
transmitting, via a computer network, the pharmacy reimbursement data packet from the first pharmacy computer system to a second payer computer system associated with a second payer and to a plurality of second pharmacy computer systems of a plurality of second pharmacies outside of the transaction and listed in a pharmacy directory;
receiving, via the computer network, a pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems, wherein each pharmacy response indicates whether a respective one of the plurality of second pharmacy computer systems determined that the pharmacy reimbursement claim is valid, the pharmacy response of each second pharmacy computer system of the plurality of second pharmacy computer systems being determined based on a pharmacy condition involving the quantity of the medication and on the requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
determining that the pharmacy reimbursement claim is validated based on the pharmacy responses from the plurality of second pharmacy computer systems;
adding an immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to a pharmacy electronic ledger, the pharmacy electronic ledger being stored by the first pharmacy computer system, the immutable pharmacy entry being cryptographically signed by the first pharmacy computer system; and
transmitting, after adding the immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to the pharmacy electronic ledger, at least a portion of the pharmacy electronic ledger that includes the immutable pharmacy entry to the second payer computer system, the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger and the validated wholesaler reimbursement claim contained in the at least a portion of the first electronic ledger causing the second payer computer system to initiate processing of the pharmacy reimbursement claim and a first payer system to initiate processing of the wholesaler reimbursement claim.
Claim 2:
The method of claim 1, wherein the receiving the pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems comprises receiving the pharmacy response from each of a selected subset of the second pharmacy computer systems listed in the pharmacy directory.
Claim 2:
The method of claim 1, wherein the receiving the pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems comprises receiving the pharmacy response from each of a selected subset of the second pharmacy computer systems listed in the pharmacy directory.
Claim 3:
The method of claim 1, wherein the pharmacy condition involves a determination whether the requested pharmacy reimbursement amount is reasonable relative to the quantity of the medication.
Claim 3:
The method of claim 1, wherein the pharmacy condition involves a determination whether the requested pharmacy reimbursement amount is reasonable relative to the quantity of the medication.
Claim 4:
The method of claim 1, wherein the pharmacy condition involves a determination whether the quantity of the medication is within reasonable limits.
Claim 4:
The method of claim 1, wherein the pharmacy condition involves a determination whether the quantity of the medication is within reasonable limits.
Claim 5:
The method of claim 1, wherein the pharmacy condition involves a determination whether the medication is normally prescribed by doctors.
Claim 5:
The method of claim 1, wherein the pharmacy condition involves a determination whether the medication is normally prescribed by doctors.
Claim 6:
The method of claim 1, wherein the pharmacy condition involves a determination whether a historical amount of the medication being dispensed by the first pharmacy is within an expected range, the expected range being calculated from an analysis of transactions on the pharmacy electronic ledger.
Claim 6:
The method of claim 1, wherein the pharmacy condition involves a determination whether a historical amount of the medication being dispensed by the first pharmacy is within an expected range, the expected range being calculated from an analysis of transactions on the pharmacy electronic ledger.
Claim 7:
The method of claim 1, wherein the plurality of second pharmacy computer systems includes all of the second pharmacy computer systems associated with a pharmacy listed in the pharmacy directory.
Claim 7:
The method of claim 1, wherein the plurality of second pharmacy computer systems includes all of the second pharmacy computer systems associated with a pharmacy listed in the pharmacy directory.
Claim 8:
The method of claim 7, wherein the pharmacy directory can be modified to add or remove particular second pharmacy computer systems.
Claim 8:
The method of claim 7, wherein the pharmacy directory can be modified to add or remove particular second pharmacy computer systems.
Claim 9:
The method of claim 1, wherein the at least the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger further causes a second payer system to initiate processing of a wholesaler reimbursement claim.
Claim 1:
the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger and the validated wholesaler reimbursement claim contained in the at least a portion of the first electronic ledger causing the second payer computer system to initiate processing of the pharmacy reimbursement claim and a first payer system to initiate processing of the wholesaler reimbursement claim.
Claim 10:
A decentralized system for initiating reimbursement of pharmacy-related transactions, the system comprising:
one or more processors; and
memory storing instructions that, when executed by the one or more processors, cause the system to perform:
receiving, at a first pharmacy computer system associated with a first pharmacy, first pharmacy data about a pharmacy transaction between a patient and the first pharmacy, wherein the pharmacy transaction comprises dispensing of a medication by the first pharmacy to the patient;
generating, at the first pharmacy computer system, a pharmacy reimbursement data packet based on the first pharmacy data, wherein the pharmacy reimbursement data packet comprises second pharmacy data about a pharmacy reimbursement claim associated with the pharmacy transaction, the second pharmacy data including a quantity of the medication dispensed by the first pharmacy to the patient and a requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
transmitting, via a computer network, the pharmacy reimbursement data packet from the first pharmacy computer system to a first payer computer system associated with a first payer and to a plurality of second pharmacy computer systems of a plurality of second pharmacies outside of the transaction and listed in a pharmacy directory;
receiving, via the computer network, a pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems, wherein each pharmacy response indicates whether a respective one of the plurality of second pharmacy computer systems determined that the pharmacy reimbursement claim is valid, the pharmacy response of each second pharmacy computer system of the plurality of second pharmacy computer systems being determined based on a pharmacy condition involving the quantity of the medication and on the requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
determining that the pharmacy reimbursement claim is validated based on the pharmacy responses from the plurality of second pharmacy computer systems;
adding an immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to a pharmacy electronic ledger, the pharmacy electronic ledger being stored by the first pharmacy computer system, the immutable pharmacy entry being cryptographically signed by the first pharmacy computer system; and
transmitting, after adding the immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to the pharmacy electronic ledger, at least a portion of the pharmacy electronic ledger that includes the immutable pharmacy entry to the first payer computer system, at least the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger causing the first payer computer system to initiate processing of the pharmacy reimbursement claim.
Claim 9:
A decentralized system for initiating reimbursement of pharmacy-related transactions, the system comprising:
one or more processors; and
memory storing instructions that, when executed by the one or more processors, cause the system to perform:
receiving first supply data about a supply transaction between a first wholesaler and a first pharmacy, wherein the supply transaction comprises supplying a medication by the first wholesaler to the first pharmacy;
generating a wholesaler reimbursement data packet based on the first supply data, wherein the wholesaler reimbursement data packet comprises second supply data about a wholesaler reimbursement claim, the second supply data including a quantity of the medication for the first pharmacy and a requested wholesaler reimbursement amount for the wholesaler reimbursement claim;
transmitting the wholesaler reimbursement data packet to a plurality of second wholesaler computer systems of a plurality of second wholesalers outside of the supply transaction and listed in a wholesaler directory;
receiving a wholesaler response from each second wholesaler computer system of the plurality of second wholesaler computer systems, wherein each wholesaler response indicates whether a respective one of the plurality of second wholesaler computer systems determined that the wholesaler reimbursement claim is valid, the wholesaler response of each second wholesaler computer system of the plurality of second wholesaler computer systems being determined based on a wholesaler condition involving the quantity of the medication and on the requested wholesaler reimbursement amount for the wholesaler reimbursement claim;
determining that the wholesaler reimbursement claim is validated based on the wholesaler responses from the plurality of second wholesaler computer systems;
adding an immutable wholesaler entry about the supply transaction and the wholesaler reimbursement claim to a first electronic ledger, the immutable wholesaler entry being cryptographically signed;
transmitting, after adding the immutable entry about the supply transaction and the wholesaler reimbursement claim to the first electronic ledger, at least a portion of the first electronic ledger that includes the immutable wholesaler entry to each second wholesaler computer system of the plurality of second wholesaler computer systems;
receiving, at a first pharmacy computer system associated with the first pharmacy, first pharmacy data about a pharmacy transaction between a patient and the first pharmacy, wherein the pharmacy transaction comprises dispensing of the medication by the first pharmacy to the patient;
generating, at the first pharmacy computer system, a pharmacy reimbursement data packet based on the first pharmacy data, wherein the pharmacy reimbursement data packet comprises second pharmacy data about a pharmacy reimbursement claim associated with the pharmacy transaction, the second pharmacy data including a quantity of the medication dispensed by the first pharmacy to the patient and a requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
transmitting, via a computer network, the pharmacy reimbursement data packet from the first pharmacy computer system to a second payer computer system associated with a second payer and to a plurality of second pharmacy computer systems of a plurality of second pharmacies outside of the transaction and listed in a pharmacy directory;
receiving, via the computer network, a pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems, wherein each pharmacy response indicates whether a respective one of the plurality of second pharmacy computer systems determined that the pharmacy reimbursement claim is valid, the pharmacy response of each second pharmacy computer system of the plurality of second pharmacy computer systems being determined based on a pharmacy condition involving the quantity of the medication and on the requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
determining that the pharmacy reimbursement claim is validated based on the pharmacy responses from the plurality of second pharmacy computer systems;
adding an immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to a pharmacy electronic ledger, the pharmacy electronic ledger being stored by the first pharmacy computer system, the immutable pharmacy entry being cryptographically signed by the first pharmacy computer system; and
transmitting, after adding the immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to the pharmacy electronic ledger, at least a portion of the pharmacy electronic ledger that includes the immutable pharmacy entry to the second payer computer system, the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger and the validated wholesaler reimbursement claim contained in the at least a portion of the first electronic ledger causing the second payer computer system to initiate processing of the pharmacy reimbursement claim and a first payer system to initiate processing of the wholesaler reimbursement claim.
Claim 11:
The system of claim 10, wherein the instructions are further configured to cause the system to receive the pharmacy response from each of a selected subset of the second pharmacy computer systems listed in the pharmacy directory.
Claim 10:
The system of claim 9, wherein the instructions are further configured to cause the system to receive the pharmacy response from each of a selected subset of the second pharmacy computer systems listed in the pharmacy directory.
Claim 12:
The system of claim 10, wherein the pharmacy condition involves a determination whether the requested pharmacy reimbursement amount is reasonable relative to the quantity of the medication.
Claim 11:
The system of claim 9, wherein the pharmacy condition involves a determination whether the requested pharmacy reimbursement amount is reasonable relative to the quantity of the medication.
Claim 13:
The system of claim 10, wherein the pharmacy condition involves a determination whether the quantity of the medication is within reasonable limits.
Claim 12:
The system of claim 9, wherein the pharmacy condition involves a determination whether the quantity of the medication is within reasonable limits.
Claim 14:
The system of claim 10, wherein the pharmacy condition involves a determination whether the medication is normally prescribed by doctors.
Claim 13:
The system of claim 9, wherein the pharmacy condition involves a determination whether the medication is normally prescribed by doctors.
Claim 15:
The system of claim 10, wherein the pharmacy condition involves a determination whether a historical amount of the medication being dispensed by the pharmacy is within an expected range, the expected range being calculated from an analysis of transactions on the pharmacy electronic ledger.
Claim 14:
The system of claim 9, wherein the pharmacy condition involves a determination whether a historical amount of the medication being dispensed by the pharmacy is within an expected range, the expected range being calculated from an analysis of transactions on the pharmacy electronic ledger.
Claim 16:
The system of claim 10, wherein the plurality of second pharmacy computer systems includes all of the second pharmacy computer systems associated with a pharmacy listed in the pharmacy directory.
Claim 15:
The system of claim 9, wherein the plurality of second pharmacy computer systems includes all of the second pharmacy computer systems associated with a pharmacy listed in the pharmacy directory.
Claim 17:
The system of claim 10, wherein the pharmacy directory can be modified to add or remove particular second pharmacy computer systems.
Claim 16:
The system of claim 15, wherein the pharmacy directory can be modified to add or remove particular second pharmacy computer systems.
Claim 18:
The decentralized system of claim 10, wherein the at least the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger further causes a second payer system to initiate processing of a wholesaler reimbursement claim.
Claim 9:
the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger and the validated wholesaler reimbursement claim contained in the at least a portion of the first electronic ledger causing the second payer computer system to initiate processing of the pharmacy reimbursement claim and a first payer system to initiate processing of the wholesaler reimbursement claim.
Claims 1-18 are rejected on the ground of nonstatutory double patenting as being unpatentable over claim 1-16 of U.S. Patent No. 118,300,00. Although the claims at issue are not identical, they are not patentably distinct from each other.
The mapping of claims 1-18 of this application with claims 1-16 of the ’000 patent is as follows:
This Application
Patent No. 11,830,000
Claim 1:
A decentralized method of initiating reimbursement of pharmacy-related transactions, the method comprising:
receiving, at a first pharmacy computer system associated with a first pharmacy, first pharmacy data about a pharmacy transaction between a patient and the first pharmacy, wherein the pharmacy transaction comprises dispensing of a medication by the first pharmacy to the patient;
generating, at the first pharmacy computer system, a pharmacy reimbursement data packet based on the first pharmacy data, wherein the pharmacy reimbursement data packet comprises second pharmacy data about a pharmacy reimbursement claim associated with the pharmacy transaction, the second pharmacy data including a quantity of the medication dispensed by the first pharmacy to the patient and a requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
transmitting, via a computer network, the pharmacy reimbursement data packet from the first pharmacy computer system to a first payer computer system associated with a first payer and to a plurality of second pharmacy computer systems of a plurality of second pharmacies outside of the transaction and listed in a pharmacy directory;
receiving, via the computer network, a pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems, wherein each pharmacy response indicates whether a respective one of the plurality of second pharmacy computer systems determined that the pharmacy reimbursement claim is valid, the pharmacy response of each second pharmacy computer system of the plurality of second pharmacy computer systems being determined based on a pharmacy condition involving the quantity of the medication and on the requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
determining that the pharmacy reimbursement claim is validated based on the pharmacy responses from the plurality of second pharmacy computer systems;
adding an immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to a pharmacy electronic ledger, the pharmacy electronic ledger being stored by the first pharmacy computer system, the immutable pharmacy entry being cryptographically signed by the first pharmacy computer system; and
transmitting, after adding the immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to the pharmacy electronic ledger, at least a portion of the pharmacy electronic ledger that includes the immutable pharmacy entry to the first payer computer system, at least the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger causing the first payer computer system to initiate processing of the pharmacy reimbursement claim.
Claim 1:
A decentralized method of initiating reimbursement of pharmacy-related transactions, the method comprising:
receiving first supply data about a supply transaction between a first wholesaler and a first pharmacy, wherein the supply transaction comprises supplying a medication by the first wholesaler to the first pharmacy;
generating a wholesaler reimbursement data packet based on the first supply data, wherein the wholesaler reimbursement data packet comprises second supply data about a wholesaler reimbursement claim, the second supply data including a quantity of the medication dispensed by the first wholesaler to the first pharmacy and a requested wholesaler reimbursement amount for the wholesaler reimbursement claim;
transmitting the wholesaler reimbursement data packet to a payer computer system of a payer and to a plurality of second wholesaler computer systems of a plurality of second wholesalers outside of the supply transaction and listed in a wholesaler directory; receiving a wholesaler response from each second wholesaler computer system of the plurality of second wholesaler computer systems, wherein each wholesaler response indicates whether a respective one of the plurality of second wholesaler computer systems determined that the wholesaler reimbursement claim is valid, the wholesaler response of each second wholesaler computer system of the plurality of second wholesaler computer systems being determined based on a wholesaler condition involving the quantity of the medication and on the requested wholesaler reimbursement amount for the wholesaler reimbursement claim;
determining that the wholesaler reimbursement claim is validated based on the wholesaler responses from the plurality of second wholesaler computer systems;
adding an immutable wholesaler entry about the supply transaction and the wholesaler reimbursement claim to a first electronic ledger, the immutable wholesaler entry being cryptographically signed;
transmitting, after adding the immutable wholesaler entry about the supply transaction and the wholesaler reimbursement claim to the first electronic ledger, at least a portion of the first electronic ledger that includes the immutable wholesaler entry to each second wholesaler computer system of the plurality of second wholesaler computer systems and to the payer computer system;
receiving, at a first pharmacy computer system associated with the first pharmacy, first pharmacy data about a pharmacy transaction between a patient and the first pharmacy, wherein the pharmacy transaction comprises dispensing of the medication by the first pharmacy to the patient;
generating, at the first pharmacy computer system, a pharmacy reimbursement data packet based on the first pharmacy data, wherein the pharmacy reimbursement data packet comprises second pharmacy data about a pharmacy reimbursement claim associated with the pharmacy transaction, the second pharmacy data including a quantity of the medication dispensed by the first pharmacy to the patient and a requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
transmitting, via a computer network, the pharmacy reimbursement data packet from the first pharmacy computer system to the payer computer system and to a plurality of second pharmacy computer systems of a plurality of second pharmacies outside of the transaction and listed in a pharmacy directory;
receiving, via the computer network, a pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems, wherein each pharmacy response indicates whether a respective one of the plurality of second pharmacy computer systems determined that the pharmacy reimbursement claim is valid, the pharmacy response of each second pharmacy computer system of the plurality of second pharmacy computer systems being determined based on a pharmacy condition involving the quantity of the medication and on the requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
determining that the pharmacy reimbursement claim is validated based on the pharmacy responses from the plurality of second pharmacy computer systems;
adding an immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to a pharmacy electronic ledger, the pharmacy electronic ledger being stored by the first pharmacy computer system, the immutable pharmacy entry being cryptographically signed by the first pharmacy computer system; and
transmitting, after adding the immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to the pharmacy electronic ledger, at least a portion of the pharmacy electronic ledger that includes the immutable pharmacy entry to the payer computer system, the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger causing the payer computer system to initiate processing of the pharmacy reimbursement claim and the wholesaler reimbursement claim.
Claim 2:
The method of claim 1, wherein the receiving the pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems comprises receiving the pharmacy response from each of a selected subset of the second pharmacy computer systems listed in the pharmacy directory.
Claim 2:
The method of claim 1, wherein the receiving the pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems comprises receiving the pharmacy response from each of a selected subset of the second pharmacy computer systems listed in the pharmacy directory.
Claim 3:
The method of claim 1, wherein the pharmacy condition involves a determination whether the requested pharmacy reimbursement amount is reasonable relative to the quantity of the medication.
Claim 3:
The method of claim 1, wherein the pharmacy condition involves a determination whether the requested pharmacy reimbursement amount is reasonable relative to the quantity of the medication.
Claim 4:
The method of claim 1, wherein the pharmacy condition involves a determination whether the quantity of the medication is within reasonable limits.
Claim 4:
The method of claim 1, wherein the pharmacy condition involves a determination whether the quantity of the medication is within reasonable limits.
Claim 5:
The method of claim 1, wherein the pharmacy condition involves a determination whether the medication is normally prescribed by doctors.
Claim 5:
The method of claim 1, wherein the pharmacy condition involves a determination whether the medication is normally prescribed by doctors.
Claim 6:
The method of claim 1, wherein the pharmacy condition involves a determination whether a historical amount of the medication being dispensed by the first pharmacy is within an expected range, the expected range being calculated from an analysis of transactions on the pharmacy electronic ledger.
Claim 6:
The method of claim 1, wherein the pharmacy condition involves a determination whether a historical amount of the medication being dispensed by the first pharmacy is within an expected range, the expected range being calculated from an analysis of transactions on the pharmacy electronic ledger.
Claim 7:
The method of claim 1, wherein the plurality of second pharmacy computer systems includes all of the second pharmacy computer systems associated with a pharmacy listed in the pharmacy directory.
Claim 7:
The method of claim 1, wherein the plurality of second pharmacy computer systems includes all of the second pharmacy computer systems associated with a pharmacy listed in the pharmacy directory.
Claim 8:
The method of claim 7, wherein the pharmacy directory can be modified to add or remove particular second pharmacy computer systems.
Claim 8:
The method of claim 7, wherein the pharmacy directory can be modified to add or remove particular second pharmacy computer systems.
Claim 9:
The method of claim 1, wherein the at least the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger further causes a second payer system to initiate processing of a wholesaler reimbursement claim.
Claim 1:
the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger causing the payer computer system to initiate processing of the pharmacy reimbursement claim and the wholesaler reimbursement claim.
Claim 10:
A decentralized system for initiating reimbursement of pharmacy-related transactions, the system comprising:
one or more processors; and
memory storing instructions that, when executed by the one or more processors, cause the system to perform:
receiving, at a first pharmacy computer system associated with a first pharmacy, first pharmacy data about a pharmacy transaction between a patient and the first pharmacy, wherein the pharmacy transaction comprises dispensing of a medication by the first pharmacy to the patient;
generating, at the first pharmacy computer system, a pharmacy reimbursement data packet based on the first pharmacy data, wherein the pharmacy reimbursement data packet comprises second pharmacy data about a pharmacy reimbursement claim associated with the pharmacy transaction, the second pharmacy data including a quantity of the medication dispensed by the first pharmacy to the patient and a requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
transmitting, via a computer network, the pharmacy reimbursement data packet from the first pharmacy computer system to a first payer computer system associated with a first payer and to a plurality of second pharmacy computer systems of a plurality of second pharmacies outside of the transaction and listed in a pharmacy directory;
receiving, via the computer network, a pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems, wherein each pharmacy response indicates whether a respective one of the plurality of second pharmacy computer systems determined that the pharmacy reimbursement claim is valid, the pharmacy response of each second pharmacy computer system of the plurality of second pharmacy computer systems being determined based on a pharmacy condition involving the quantity of the medication and on the requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
determining that the pharmacy reimbursement claim is validated based on the pharmacy responses from the plurality of second pharmacy computer systems;
adding an immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to a pharmacy electronic ledger, the pharmacy electronic ledger being stored by the first pharmacy computer system, the immutable pharmacy entry being cryptographically signed by the first pharmacy computer system; and
transmitting, after adding the immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to the pharmacy electronic ledger, at least a portion of the pharmacy electronic ledger that includes the immutable pharmacy entry to the first payer computer system, at least the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger causing the first payer computer system to initiate processing of the pharmacy reimbursement claim.
Claim 9:
A decentralized system for initiating reimbursement of pharmacy-related transactions, the system comprising:
one or more processors; and
memory storing instructions that, when executed by the one or more processors, cause the system to perform:
receiving first supply data about a supply transaction between a first wholesaler and a first pharmacy, wherein the supply transaction comprises supplying a medication by the first wholesaler to the first pharmacy;
generating a wholesaler reimbursement data packet based on the first supply data, wherein the wholesaler reimbursement data packet comprises second supply data about a wholesaler reimbursement claim, the second supply data including a quantity of the medication dispensed by the first wholesaler to the first pharmacy and a requested wholesaler reimbursement amount for the wholesaler reimbursement claim;
transmitting the wholesaler reimbursement data packet to a payer computer system of a payer and to a plurality of second wholesaler computer systems of a plurality of second wholesalers outside of the supply transaction and listed in a wholesaler directory;
receiving a wholesaler response from each second wholesaler computer system of the plurality of second wholesaler computer systems, wherein each wholesaler response indicates whether a respective one of the plurality of second wholesaler computer systems determined that the wholesaler reimbursement claim is valid, the wholesaler response of each second wholesaler computer system of the plurality of second wholesaler computer systems being determined based on a wholesaler condition involving the quantity of the medication and on the requested wholesaler reimbursement amount for the wholesaler reimbursement claim;
determining that the wholesaler reimbursement claim is validated based on the wholesaler responses from the plurality of second wholesaler computer systems;
adding an immutable wholesaler entry about the supply transaction and the wholesaler reimbursement claim to a first electronic ledger, the immutable wholesaler entry being cryptographically signed; transmitting, after adding the immutable entry about the supply transaction and the wholesaler reimbursement claim to the first electronic ledger, at least a portion of the first electronic ledger that includes the immutable wholesaler entry to each second wholesaler computer system of the plurality of second wholesaler computer systems and to the payer computer system;
receiving, at a first pharmacy computer system associated with the first pharmacy, first pharmacy data about a pharmacy transaction between a patient and the first pharmacy, wherein the pharmacy transaction comprises dispensing of the medication by the first pharmacy to the patient;
generating, at the first pharmacy computer system, a pharmacy reimbursement data packet based on the first pharmacy data, wherein the pharmacy reimbursement data packet comprises second pharmacy data about a pharmacy reimbursement claim associated with the pharmacy transaction, the second pharmacy data including a quantity of the medication dispensed by the first pharmacy to the patient and a requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
transmitting, via a computer network, the pharmacy reimbursement data packet from the first pharmacy computer system to the payer computer system and to a plurality of second pharmacy computer systems of a plurality of second pharmacies outside of the transaction and listed in a pharmacy directory;
receiving, via the computer network, a pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems, wherein each pharmacy response indicates whether a respective one of the plurality of second pharmacy computer systems determined that the pharmacy reimbursement claim is valid, the pharmacy response of each second pharmacy computer system of the plurality of second pharmacy computer systems being determined based on a pharmacy condition involving the quantity of the medication and on the requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
determining that the pharmacy reimbursement claim is validated based on the pharmacy responses from the plurality of second pharmacy computer systems;
adding an immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to a pharmacy electronic ledger, the pharmacy electronic ledger being stored by the first pharmacy computer system, the immutable pharmacy entry being cryptographically signed by the first pharmacy computer system; and
transmitting, after adding the immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to the pharmacy electronic ledger, at least a portion of the pharmacy electronic ledger that includes the immutable pharmacy entry to the payer computer system, the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger causing the payer computer system to initiate processing of the pharmacy reimbursement claim and the wholesaler reimbursement claim.
Claim 11:
The system of claim 10, wherein the instructions are further configured to cause the system to receive the pharmacy response from each of a selected subset of the second pharmacy computer systems listed in the pharmacy directory.
Claim 10:
The system of claim 9, wherein the instructions are further configured to cause the system to receive the pharmacy response from each of a selected subset of the second pharmacy computer systems listed in the pharmacy directory.
Claim 12:
The system of claim 10, wherein the pharmacy condition involves a determination whether the requested pharmacy reimbursement amount is reasonable relative to the quantity of the medication.
Claim 11:
The system of claim 9, wherein the pharmacy condition involves a determination whether the requested pharmacy reimbursement amount is reasonable relative to the quantity of the medication.
Claim 13:
The system of claim 10, wherein the pharmacy condition involves a determination whether the quantity of the medication is within reasonable limits.
Claim 12:
The system of claim 9, wherein the pharmacy condition involves a determination whether the quantity of the medication is within reasonable limits.
Claim 14:
The system of claim 10, wherein the pharmacy condition involves a determination whether the medication is normally prescribed by doctors.
Claim 13:
The system of claim 9, wherein the pharmacy condition involves a determination whether the medication is normally prescribed by doctors.
Claim 15:
The system of claim 10, wherein the pharmacy condition involves a determination whether a historical amount of the medication being dispensed by the pharmacy is within an expected range, the expected range being calculated from an analysis of transactions on the pharmacy electronic ledger.
Claim 14:
The system of claim 9, wherein the pharmacy condition involves a determination whether a historical amount of the medication being dispensed by the pharmacy is within an expected range, the expected range being calculated from an analysis of transactions on the pharmacy electronic ledger.
Claim 16:
The system of claim 10, wherein the plurality of second pharmacy computer systems includes all of the second pharmacy computer systems associated with a pharmacy listed in the pharmacy directory.
Claim 15:
The system of claim 9, wherein the plurality of second pharmacy computer systems includes all of the second pharmacy computer systems associated with a pharmacy listed in the pharmacy directory.
Claim 17:
The system of claim 10, wherein the pharmacy directory can be modified to add or remove particular second pharmacy computer systems.
Claim 16:
The system of claim 15, wherein the pharmacy directory can be modified to add or remove particular second pharmacy computer systems.
Claim 18:
The decentralized system of claim 10, wherein the at least the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger further causes a second payer system to initiate processing of a wholesaler reimbursement claim.
Claim 9:
the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger causing the payer computer system to initiate processing of the pharmacy reimbursement claim and the wholesaler reimbursement claim.
Claims 1-18 are rejected on the ground of nonstatutory double patenting as being unpatentable over claim 1-16 of U.S. Patent No. 11,244,310. Although the claims at issue are not identical, they are not patentably distinct from each other.
The mapping of claims 1-18 of this application with claims 1-16 of the ’310 patent is as follows:
This Application
Patent No. 11,244,310
Claim 1:
A decentralized method of initiating reimbursement of pharmacy-related transactions, the method comprising:
receiving, at a first pharmacy computer system associated with a first pharmacy, first pharmacy data about a pharmacy transaction between a patient and the first pharmacy, wherein the pharmacy transaction comprises dispensing of a medication by the first pharmacy to the patient;
generating, at the first pharmacy computer system, a pharmacy reimbursement data packet based on the first pharmacy data, wherein the pharmacy reimbursement data packet comprises second pharmacy data about a pharmacy reimbursement claim associated with the pharmacy transaction, the second pharmacy data including a quantity of the medication dispensed by the first pharmacy to the patient and a requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
transmitting, via a computer network, the pharmacy reimbursement data packet from the first pharmacy computer system to a first payer computer system associated with a first payer and to a plurality of second pharmacy computer systems of a plurality of second pharmacies outside of the transaction and listed in a pharmacy directory;
receiving, via the computer network, a pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems, wherein each pharmacy response indicates whether a respective one of the plurality of second pharmacy computer systems determined that the pharmacy reimbursement claim is valid, the pharmacy response of each second pharmacy computer system of the plurality of second pharmacy computer systems being determined based on a pharmacy condition involving the quantity of the medication and on the requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
determining that the pharmacy reimbursement claim is validated based on the pharmacy responses from the plurality of second pharmacy computer systems;
adding an immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to a pharmacy electronic ledger, the pharmacy electronic ledger being stored by the first pharmacy computer system, the immutable pharmacy entry being cryptographically signed by the first pharmacy computer system; and
transmitting, after adding the immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to the pharmacy electronic ledger, at least a portion of the pharmacy electronic ledger that includes the immutable pharmacy entry to the first payer computer system, at least the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger causing the first payer computer system to initiate processing of the pharmacy reimbursement claim.
Claim 1:
A decentralized method of initiating reimbursement of pharmacy-related transactions, the method comprising:
receiving first supply data about a supply transaction between a first wholesaler and a first pharmacy, wherein the supply transaction comprises supplying a medication by the first wholesaler to the first pharmacy; generating a wholesaler reimbursement data packet based on the first supply data, wherein the wholesaler reimbursement data packet comprises second supply data about a wholesaler reimbursement claim, the second supply data including a quantity of the medication dispensed by the first wholesaler to the first pharmacy and a requested wholesaler reimbursement amount for the wholesaler reimbursement claim;
transmitting the wholesaler reimbursement data packet to a payer computer system of a payer and to a plurality of second wholesaler computer systems of a plurality of second wholesalers outside of the supply transaction and listed in a wholesaler directory;
receiving a wholesaler response from each second wholesaler computer system of the plurality of second wholesaler computer systems, wherein each wholesaler response indicates whether a respective one of the plurality of second wholesaler computer systems determined that the wholesaler reimbursement claim is valid, the wholesaler response of each second wholesaler computer system of the plurality of second wholesaler computer systems being determined based on a wholesaler condition involving the quantity of the medication and on the requested wholesaler reimbursement amount for the wholesaler reimbursement claim;
determining that the wholesaler reimbursement claim is validated based on the wholesaler responses from the plurality of second wholesaler computer systems;
adding an immutable wholesaler entry about the supply transaction and the wholesaler reimbursement claim to a first electronic ledger, the immutable wholesaler entry being cryptographically signed;
transmitting, after adding the immutable wholesaler entry about the supply transaction and the wholesaler reimbursement claim to the first electronic ledger, at least a portion of the first electronic ledger that includes the immutable wholesaler entry to each second wholesaler computer system of the plurality of second wholesaler computer systems and to the payer computer system;
receiving, at a first pharmacy computer system associated with the first pharmacy, first pharmacy data about a pharmacy transaction between a patient and the first pharmacy, wherein the pharmacy transaction comprises dispensing of the medication by the first pharmacy to the patient;
generating, at the first pharmacy computer system, a pharmacy reimbursement data packet based on the first pharmacy data, wherein the pharmacy reimbursement data packet comprises second pharmacy data about a pharmacy reimbursement claim associated with the payer for the pharmacy transaction, the second data including a quantity of the medication dispensed by the first pharmacy to the patient and a requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
transmitting, via a computer network, the pharmacy reimbursement data packet from the first pharmacy computer system to a payer computer system of the payer and to a plurality of second pharmacy computer systems of a plurality of second pharmacies outside of the transaction and listed in a pharmacy directory;
receiving, via the computer network, a pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems, wherein each pharmacy response indicates whether a respective one of the plurality of second pharmacy computer systems determined that the pharmacy reimbursement claim is valid, the pharmacy response of each second pharmacy computer system of the plurality of second pharmacy computer systems being determined based on a pharmacy condition involving the quantity of the medication and on the requested pharmacy reimbursement amount for the pharmacy reimbursement claim, wherein each pharmacy response from the each second pharmacy computer system of the plurality of second pharmacy computer systems includes a confidence level;
determining that the pharmacy reimbursement claim is validated based on the pharmacy responses from the plurality of second pharmacy computer systems;
adding an immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to a pharmacy electronic ledger, the pharmacy electronic ledger being stored by the first pharmacy computer system, the immutable pharmacy entry being cryptographically signed by the first pharmacy computer system; and
transmitting, after adding the immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to the pharmacy electronic ledger, at least a portion of the pharmacy electronic ledger that includes the immutable pharmacy entry to the payer computer system, the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger causing the payer computer system to initiate processing of the pharmacy reimbursement claim and the wholesaler reimbursement claim.
Claim 2:
The method of claim 1, wherein the receiving the pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems comprises receiving the pharmacy response from each of a selected subset of the second pharmacy computer systems listed in the pharmacy directory.
Claim 2:
The method of claim 1, wherein the receiving the pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems comprises receiving the pharmacy response from each of a selected subset of the second pharmacy computer systems listed in the pharmacy directory.
Claim 3:
The method of claim 1, wherein the pharmacy condition involves a determination whether the requested pharmacy reimbursement amount is reasonable relative to the quantity of the medication.
Claim 3:
The method of claim 1, wherein the pharmacy condition involves a determination whether the requested pharmacy reimbursement amount is reasonable relative to the quantity of the medication.
Claim 4:
The method of claim 1, wherein the pharmacy condition involves a determination whether the quantity of the medication is within reasonable limits.
Claim 4:
The method of claim 1, wherein the pharmacy condition involves a determination whether the quantity of the medication is within reasonable limits.
Claim 5:
The method of claim 1, wherein the pharmacy condition involves a determination whether the medication is normally prescribed by doctors.
Claim 5:
The method of claim 1, wherein the pharmacy condition involves a determination whether the medication is normally prescribed by doctors.
Claim 6:
The method of claim 1, wherein the pharmacy condition involves a determination whether a historical amount of the medication being dispensed by the first pharmacy is within an expected range, the expected range being calculated from an analysis of transactions on the pharmacy electronic ledger.
Claim 6:
The method of claim 1, wherein the pharmacy condition involves a determination whether a historical amount of the medication being dispensed by the first pharmacy is within an expected range, the expected range being calculated from an analysis of transactions on the pharmacy electronic ledger.
Claim 7:
The method of claim 1, wherein the plurality of second pharmacy computer systems includes all of the second pharmacy computer systems associated with a pharmacy listed in the pharmacy directory.
Claim 7:
The method of claim 1, wherein the plurality of second pharmacy computer systems includes all of the second pharmacy computer systems associated with a pharmacy listed in the pharmacy directory.
Claim 8:
The method of claim 7, wherein the pharmacy directory can be modified to add or remove particular second pharmacy computer systems.
Claim 8:
The method of claim 7, wherein the pharmacy directory can be modified to add or remove particular second pharmacy computer systems.
Claim 9:
The method of claim 1, wherein the at least the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger further causes a second payer system to initiate processing of a wholesaler reimbursement claim.
Claim 1:
the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger causing the payer computer system to initiate processing of the pharmacy reimbursement claim and the wholesaler reimbursement claim.
Claim 10:
A decentralized system for initiating reimbursement of pharmacy-related transactions, the system comprising:
one or more processors; and
memory storing instructions that, when executed by the one or more processors, cause the system to perform:
receiving, at a first pharmacy computer system associated with a first pharmacy, first pharmacy data about a pharmacy transaction between a patient and the first pharmacy, wherein the pharmacy transaction comprises dispensing of a medication by the first pharmacy to the patient;
generating, at the first pharmacy computer system, a pharmacy reimbursement data packet based on the first pharmacy data, wherein the pharmacy reimbursement data packet comprises second pharmacy data about a pharmacy reimbursement claim associated with the pharmacy transaction, the second pharmacy data including a quantity of the medication dispensed by the first pharmacy to the patient and a requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
transmitting, via a computer network, the pharmacy reimbursement data packet from the first pharmacy computer system to a first payer computer system associated with a first payer and to a plurality of second pharmacy computer systems of a plurality of second pharmacies outside of the transaction and listed in a pharmacy directory;
receiving, via the computer network, a pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems, wherein each pharmacy response indicates whether a respective one of the plurality of second pharmacy computer systems determined that the pharmacy reimbursement claim is valid, the pharmacy response of each second pharmacy computer system of the plurality of second pharmacy computer systems being determined based on a pharmacy condition involving the quantity of the medication and on the requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
determining that the pharmacy reimbursement claim is validated based on the pharmacy responses from the plurality of second pharmacy computer systems;
adding an immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to a pharmacy electronic ledger, the pharmacy electronic ledger being stored by the first pharmacy computer system, the immutable pharmacy entry being cryptographically signed by the first pharmacy computer system; and
transmitting, after adding the immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to the pharmacy electronic ledger, at least a portion of the pharmacy electronic ledger that includes the immutable pharmacy entry to the first payer computer system, at least the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger causing the first payer computer system to initiate processing of the pharmacy reimbursement claim.
Claim 9:
A decentralized system for initiating reimbursement of pharmacy-related transactions, the system comprising:
one or more processors; and
memory storing instructions that, when executed by the one or more processors, cause the system to perform:
receiving first supply data about a supply transaction between a first wholesaler and a first pharmacy, wherein the supply transaction comprises supplying a medication by the first wholesaler to the first pharmacy;
generating a wholesaler reimbursement data packet based on the first supply data, wherein the wholesaler reimbursement data packet comprises second supply data about a wholesaler reimbursement claim, the second supply data including a quantity of the medication dispensed by the first wholesaler to the first pharmacy and a requested wholesaler reimbursement amount for the wholesaler reimbursement claim;
transmitting the wholesaler reimbursement data packet to a payer computer system of a payer and to a plurality of second wholesaler computer systems of a plurality of second wholesalers outside of the supply transaction and listed in a wholesaler directory;
receiving a wholesaler response from each second wholesaler computer system of the plurality of second wholesaler computer systems, wherein each wholesaler response indicates whether a respective one of the plurality of second wholesaler computer systems determined that the wholesaler reimbursement claim is valid, the wholesaler response of each second wholesaler computer system of the plurality of second wholesaler computer systems being determined based on a wholesaler condition involving the quantity of the medication and on the requested wholesaler reimbursement amount for the wholesaler reimbursement claim;
determining that the wholesaler reimbursement claim is validated based on the wholesaler responses from the plurality of second wholesaler computer systems;
adding an immutable wholesaler entry about the supply transaction and the wholesaler reimbursement claim to a first electronic ledger, the immutable wholesaler entry being cryptographically signed;
transmitting, after adding the immutable supplier entry about the supply transaction and the wholesaler reimbursement claim to the first electronic ledger, at least a portion of the first electronic ledger that includes the immutable wholesaler entry to each second wholesaler computer system of the plurality of second wholesaler computer systems and to the payer computer system;
receiving, at a first pharmacy computer system associated with the first pharmacy, first pharmacy data about a pharmacy transaction between a patient and the first pharmacy, wherein the pharmacy transaction comprises dispensing of the medication by the first pharmacy to the patient;
generating, at the first pharmacy computer system, a pharmacy reimbursement data packet based on the first pharmacy data, wherein the pharmacy reimbursement data packet comprises second pharmacy data about a pharmacy reimbursement claim associated with the payer for the pharmacy transaction, the second data including a quantity of the medication dispensed by the first pharmacy to the patient and a requested pharmacy reimbursement amount for the pharmacy reimbursement claim;
transmitting, via a computer network, the pharmacy reimbursement data packet from the first pharmacy computer system to a payer computer system of the payer and to a plurality of second pharmacy computer systems of a plurality of second pharmacies outside of the transaction and listed in a pharmacy directory;
receiving, via the computer network, a pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems, wherein each pharmacy response indicates whether a respective one of the plurality of second pharmacy computer systems determined that the pharmacy reimbursement claim is valid, the pharmacy response of each second pharmacy computer system of the plurality of second pharmacy computer systems being determined based on a pharmacy condition involving the quantity of the medication and on the requested pharmacy reimbursement amount for the pharmacy reimbursement claim, wherein each pharmacy response from the each second pharmacy computer system of the plurality of second pharmacy computer systems includes a confidence level;
determining that the pharmacy reimbursement claim is validated based on the pharmacy responses from the plurality of second pharmacy computer systems; adding an immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to a pharmacy electronic ledger, the pharmacy electronic ledger being stored by the first pharmacy computer system, the immutable pharmacy entry being cryptographically signed by the first pharmacy computer system; and
transmitting, after adding the immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to the pharmacy electronic ledger, at least a portion of the pharmacy electronic ledger that includes the immutable pharmacy entry to the payer computer system, the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger causing the payer computer system to initiate processing of the pharmacy reimbursement claim and the wholesaler reimbursement claim.
Claim 11:
The system of claim 10, wherein the instructions are further configured to cause the system to receive the pharmacy response from each of a selected subset of the second pharmacy computer systems listed in the pharmacy directory.
Claim 10:
The system of claim 9, wherein the instructions are further configured to cause the system to receive the pharmacy response from each of a selected subset of the second pharmacy computer systems listed in the pharmacy directory.
Claim 12:
The system of claim 10, wherein the pharmacy condition involves a determination whether the requested pharmacy reimbursement amount is reasonable relative to the quantity of the medication.
Claim 11:
The system of claim 9, wherein the pharmacy condition involves a determination whether the requested pharmacy reimbursement amount is reasonable relative to the quantity of the medication.
Claim 13:
The system of claim 10, wherein the pharmacy condition involves a determination whether the quantity of the medication is within reasonable limits.
Claim 12:
The system of claim 9, wherein the pharmacy condition involves a determination whether the quantity of the medication is within reasonable limits.
Claim 14:
The system of claim 10, wherein the pharmacy condition involves a determination whether the medication is normally prescribed by doctors.
Claim 13:
The system of claim 9, wherein the pharmacy condition involves a determination whether the medication is normally prescribed by doctors.
Claim 15:
The system of claim 10, wherein the pharmacy condition involves a determination whether a historical amount of the medication being dispensed by the pharmacy is within an expected range, the expected range being calculated from an analysis of transactions on the pharmacy electronic ledger.
Claim 14:
The system of claim 9, wherein the pharmacy condition involves a determination whether a historical amount of the medication being dispensed by the pharmacy is within an expected range, the expected range being calculated from an analysis of transactions on the pharmacy electronic ledger.
Claim 16:
The system of claim 10, wherein the plurality of second pharmacy computer systems includes all of the second pharmacy computer systems associated with a pharmacy listed in the pharmacy directory.
Claim 15:
The system of claim 9, wherein the plurality of second pharmacy computer systems includes all of the second pharmacy computer systems associated with a pharmacy listed in the pharmacy directory.
Claim 17:
The system of claim 10, wherein the pharmacy directory can be modified to add or remove particular second pharmacy computer systems.
Claim 16:
The system of claim 15, wherein the pharmacy directory can be modified to add or remove particular second pharmacy computer systems.
Claim 18:
The decentralized system of claim 10, wherein the at least the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger further causes a second payer system to initiate processing of a wholesaler reimbursement claim.
Claim 9:
the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger causing the payer computer system to initiate processing of the pharmacy reimbursement claim and the wholesaler reimbursement claim.
Claim Rejections - 35 USC § 101
35 U.S.C. 101 reads as follows:
Whoever invents or discovers any new and useful process, machine, manufacture, or composition of matter, or any new and useful improvement thereof, may obtain a patent therefor, subject to the conditions and requirements of this title.
Claims 1-18 are rejected under 35 U.S.C. 101 because the claimed invention is directed to an abstract idea without significantly more.
In this instance, claims 1-9 are directed to a method, and claims 10-18 are directed to a system comprising one or more processors and memory. Therefore, claims 1-18 fall within the four statutory categories of invention.
Claim 1 as a whole is directed to processing a reimbursement claim. In particular, the claim recites processing a reimbursement claim by validating the claims via different entities. In other words, the claim falls under the “Certain Methods of Organizing Human Activity” grouping of abstract ideas in Step 2A Prong One (MPEP 2106.04(a)(d)) because the claim involves the steps for processing a reimbursement claim by validating the claims via different entities, which is a process related to fundamental economic practices and/or commercial interactions. More specifically, the following underlined claim elements recite an abstract idea while the non-underlined claim elements recite additional elements according to MPEP 2106.04(a).
Claim 1 recites “[a] decentralized method of initiating reimbursement of pharmacy-related transactions, the method comprising: receiving, at a first pharmacy computer system associated with a first pharmacy, first pharmacy data about a pharmacy transaction between a patient and the first pharmacy, wherein the pharmacy transaction comprises dispensing of a medication by the first pharmacy to the patient; generating, at the first pharmacy computer system, a pharmacy reimbursement data packet based on the first pharmacy data, wherein the pharmacy reimbursement data packet comprises second pharmacy data about a pharmacy reimbursement claim associated with the pharmacy transaction, the second pharmacy data including a quantity of the medication dispensed by the first pharmacy to the patient and a requested pharmacy reimbursement amount for the pharmacy reimbursement claim; transmitting, via a computer network, the pharmacy reimbursement data packet from the first pharmacy computer system to a first payer computer system associated with a first payer and to a plurality of second pharmacy computer systems of a plurality of second pharmacies outside of the transaction and listed in a pharmacy directory; receiving, via the computer network, a pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems, wherein each pharmacy response indicates whether a respective one of the plurality of second pharmacy computer systems determined that the pharmacy reimbursement claim is valid, the pharmacy response of each second pharmacy computer system of the plurality of second pharmacy computer systems being determined based on a pharmacy condition involving the quantity of the medication and on the requested pharmacy reimbursement amount for the pharmacy reimbursement claim; determining that the pharmacy reimbursement claim is validated based on the pharmacy responses from the plurality of second pharmacy computer systems; adding an immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to a pharmacy electronic ledger, the pharmacy electronic ledger being stored by the first pharmacy computer system, the immutable pharmacy entry being cryptographically signed by the first pharmacy computer system; and transmitting, after adding the immutable pharmacy entry about the pharmacy transaction and the pharmacy reimbursement claim to the pharmacy electronic ledger, at least a portion of the pharmacy electronic ledger that includes the immutable pharmacy entry to the first payer computer system, at least the validated pharmacy reimbursement claim contained in the at least a portion of the pharmacy electronic ledger causing the first payer computer system to initiate processing of the pharmacy reimbursement claim.”
This judicial exception is not integrated into a practical application because, when analyzed under Step 2A Prong Two (MPEP 2106.04(d)), the non-underlined additional elements — computers, a computer network, and a pharmacy electronic ledger in claim 1 — perform processing a reimbursement claim. These additional elements are recited at a high level of generality such that they amount to no more than mere instructions to apply the exception using generic computer components. Merely adding generic computer components to perform the abstract idea does not integrate the abstract idea into a practical application. The additional element of a pharmacy electronic ledger is only recited as a database for storing data associated with the reimbursement claim. The additional element of the pharmacy electronic ledger stored by the first pharmacy computer system merely describes the characteristics of the identified additional element of the pharmacy electronic ledger. Those additional elements do not involve improvements to the functioning of a computer, or to any other technology or technical field (MPEP 2106.05(a)); the claim does not apply the abstract idea with, or by use of, a particular machine (MPEP 2106.05(b)); and the claim does not apply or use the abstract idea in some other meaningful ways beyond generally linking the use of the abstract idea to a particular technological environment, such that the claim as a whole is more than a drafting effort designed to monopolize the exception (MPEP 2106.05(e) and Vanda Memo). Therefore, the claim does not, for example, purport to improve the functioning of a computer. Nor does it effect an improvement in any other technology or technical field. Accordingly, the additional elements do not impose any meaningful limits on practicing the abstract idea. Claim 1 as a whole, judging from the additional elements individually and in combination, does not integrate the judicial exception into a practical application. Therefore, claim 1 as a whole fails to recite a practical application of the abstract idea.
Claim 1 does not include additional elements that are sufficient to amount to significantly more than the judicial exception because, when analyzed under Step 2B (MPEP 2106.05), using computers, a computer network, and a pharmacy electronic ledger to perform processing a reimbursement claim amounts to no more than mere instructions to apply the exception using generic computer components. Mere instructions to apply an exception using generic computer components cannot provide an inventive concept beyond the recited abstract idea. The additional element of a pharmacy electronic ledger is only recited as a database for storing data associated with the reimbursement claim. The additional element of the pharmacy electronic ledger stored by the first pharmacy computer system merely describes the characteristics of the identified additional element of the pharmacy electronic ledger. As discussed above, taking the additional elements separately, these additional elements perform the steps or functions that correspond to the actions required to perform the abstract idea. Therefore, the additional claim elements, when considered individually and in combination, fail to recite significantly more than the abstract idea.
Accordingly, claim 1 is rejected as being directed toward patent-ineligible subject matter.
Claim 10 recites the abstract idea similar to that discussed above in connection with claim 1. As analyzed above, the additional elements of computers, a system comprising one or more processors and memory, a computer network, and a pharmacy electronic ledger are recited at a high level of generality such that they amount to no more than mere instructions to apply the exception using generic computer components. The additional element of the pharmacy electronic ledger stored by the first pharmacy computer system merely describes the characteristics of the identified additional element of the pharmacy electronic ledger. These additional elements do not integrate the judicial exception into a practical application and fail to recite significantly more than the abstract idea.
Claims 2-9 and 11-18 have also been considered for subject-matter eligibility. However, these claims fail to recite patent-eligible subject matter for the following reasons:
Claims 2 and 11 recite wherein the receiving of the pharmacy response from each second pharmacy system of the plurality of second pharmacy systems comprises receiving the pharmacy response from each of a selected subset of the second pharmacy systems listed in the pharmacy directory, which falls under the “Certain Method of Organizing Human Activity” grouping of abstract ideas. The additional elements of computers and a system comprising one or more processors and memory are recited at a high level of generality such that they amount to no more than mere instructions to apply the exception using generic computer components. These additional elements do not integrate the judicial exception into a practical application and fail to recite significantly more than the abstract idea.
Claims 3 and 12 recite an additional element of wherein the pharmacy condition involves a determination whether the requested pharmacy reimbursement amount is reasonably relative to the quantity of the medication. The additional element fails to recite patent-eligible subject matter as it simply describes the characteristics of the pharmacy condition included in the abstract idea. The additional element is insufficient to integrate the abstract idea into a practical application and does not offer significantly more than the abstract idea because the additional element merely recites additional instructions to implement the abstract idea.
Claims 4 and 13 recite an additional element of wherein the pharmacy condition involves a determination whether the requested pharmacy reimbursement amount is reasonably relative to the quantity of the medication. The additional element fails to recite patent-eligible subject matter as it simply describes the characteristics of the pharmacy condition included in the abstract idea. The additional element is insufficient to integrate the abstract idea into a practical application and does not offer significantly more than the abstract idea because the additional element merely recites additional instructions to implement the abstract idea.
Claim 5 and 14 recite an additional element of wherein the pharmacy condition involves a determination whether the medication is normally prescribed by doctors. The additional element fails to recite patent-eligible subject matter as it simply describes the characteristics of the pharmacy condition included in the abstract idea. The additional element is insufficient to integrate the abstract idea into a practical application and does not offer significantly more than the abstract idea because the additional element merely recites additional instructions to implement the abstract idea.
Claims 6 and 15 recite an additional element of wherein the pharmacy condition involves a determination whether a historical amount of the medication being dispensed by the first pharmacy is within an expected range, the expected range being calculated from an analysis of transactions on the pharmacy electronic ledger. The additional element fails to recite patent-eligible subject matter as it simply describes the characteristics of the pharmacy condition included in the abstract idea. The additional element is insufficient to integrate the abstract idea into a practical application and does not offer significantly more than the abstract idea because the additional element merely recites additional instructions to implement the abstract idea.
Claims 7 and 16 recite an additional element of wherein the plurality of second pharmacy computer systems includes all of the second pharmacy computer systems associated with a pharmacy listed in the pharmacy directory. The additional element fails to recite patent-eligible subject matter as it simply describes the characteristics of the plurality of second pharmacy computer systems. The additional element is insufficient to integrate the abstract idea into a practical application and does not offer significantly more than the abstract idea because the additional element merely recites additional instructions to implement the abstract idea.
Claims 8 and 17 recite an additional element of wherein the pharmacy directory can be modified to add or remove particular second pharmacy computer systems. The additional element fails to recite patent-eligible subject matter as it simply describes the characteristics of the pharmacy directory included in the abstract idea. The additional element is insufficient to integrate the abstract idea into a practical application and does not offer significantly more than the abstract idea because the additional element merely recites additional instructions to implement the abstract idea.
Claims 9 and 18 recite wherein the at least validated pharmacy reimbursement claim contained further causes a second payer system to initiate processing of a wholesaler reimbursement claim, which falls under the “Certain Method of Organizing Human Activity” grouping of abstract ideas. The additional element of a pharmacy electronic ledger is recited at a high level of generality such that it amounts to no more than mere instructions to apply the exception using generic a computer component. Additionally, the additional element of a pharmacy electronic ledger is merely recited as a database for storing data associated with the reimbursement claim. The additional element does not integrate the judicial exception into a practical application and fails to recite significantly more than the abstract idea.
Conclusion
The prior art, made of record and not relied upon, is considered pertinent to the applicant’s disclosure.
Rowe, III et al. (US 8489411 B1) discloses a method of auditing claim reimbursement transactions to ensure that pharmacy benefit management (PBM) services properly calculate the appropriate spread values and honor existing contractual obligations with health plans and/or employer groups. A pharmacy POS device receives prescription claim data, generates a claim reimbursement package including the quantity of medication and the cost, and transmits the generated claim reimbursement package to a host server. The host server forwards the received claim reimbursement package to a PBM and/or a payer system. The PBM and/or payer system may validate the claim and return an authorization or rejection message back to the host server.
Witchey (US 20150332283 A1) discloses a transaction validation system of processing all kinds of healthcare transactions between a patient and another entity, e.g., a doctor, an insurance company, or a pharmacy. Healthcare transactions associated with the patient are compiled into a chain of transaction blocks. When a transaction is conducted, the corresponding healthcare parameters are sent to one or more validation devices. The one or more validation devices could be peers associated with other entities, such as a payer system. The validation devices establish validity of the transaction and generate a new block via a proof-of-work consensus mechanism. Once the new block has been created, it can be appended to the healthcare blockchain.
Johnsrud et al. (US 20170243177 A1) discloses embodiments that enable a system operatively connected with a blockchain network to use the blockchain for routing of process authorization and settlement based on specified parameters. Rules may be established to ensure the validity of a transaction. A signed transaction record/request placed on the blockchain initiates execution of the transaction validation rules and, once a predetermined threshold number of validation nodes have agreed that the transaction validation has been satisfied, the transaction may be settled. The validation nodes can be adjusted based on the validation requirements.
Tanner et al. (US 20170039330 A1) discloses a decentralized autonomous healthcare economy platform. The Health Blockchain itself is organized as a distributed database of data blocks, or replicated shared ledger, in a constantly growing linked list, where each block is cryptographically verified by multiple nodes on the network. A sender of a transaction creates conditions that actors in a system must meet in order to claim the output. In this way any automated system of checks, authorizations, actions or even external events can be involved and validated as part of the transaction.
Gong (US 20130311370 A1) discloses transmitting a transaction to one or more entities based on a routing rule and receiving confirmation from the one or more entities.
Tu et al. (US 20120089847 A1) discloses transmitting an authorization request to one or more devices associated with one or more authorizers on a list, receiving an authorization response from the one or more devices, and determining whether a predetermined level of authorization is received.
Dooley et al. (US 20060212318 A1) discloses reimbursing prescription fulfillment that includes identifying a drug associated with a claim submitted by a pharmacy for reimbursement by a payer and identifying a change in a manufacturer set price associated with the drug. The invention includes monitoring reimbursed claims received from at least one payer, where one of the reimbursed claims received from the payer is associated with the drug, and determining if the payer has updated the internal pricing value associated with the drug. The invention further includes generating a report that includes the payer's updated internal pricing value associated with the drug, and/or creating and submitting a reversal transaction to the at least one payer followed by a resubmission of the original claim.
Thomas et al. (US 20160224949 A1) discloses resolving transactions in a consensus payment network comprising a plurality of nodes. A payer computer system comprises a ledger for the payer and a payee computer system comprises a ledger for the payee. A temporary consensus subnetwork comprising a set of validation nodes is identified as acceptable to the payer system and the payee system. A transaction from the payor to the payee is processed based on a determination of consensus from the consensus subnetwork.
Harris et al. (US 10423759 B1) discloses that an adjudicated response to a healthcare transaction for a product or service for a patient is received and includes a transaction submission time, and transaction comparison data. The transaction comparison data can be compared with a multitude of transaction records of previously processed healthcare transactions to identify a match. The transaction submission time for each of the received healthcare transactions and stored healthcare transactions can be received and compared with one another to determine a submission time difference between the submission time for the healthcare transaction and the stored healthcare transaction. The submission time difference can be compared with a time limit threshold to determine if the difference satisfies the time limit threshold. Based on the determination that the submission time difference satisfies the threshold, the received healthcare transaction can be determined to be a request for a service, such as prior authorization assistance.
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/CHUNLING DING/Primary Examiner, Art Unit 3699